Last chance to save with early registration for APHA 2024! Join us in Minneapolis ×

Toward a World Free of Nuclear Weapons

  • Date: Oct 24 2020
  • Policy Number: 20209

Key Words: Nuclear Weapons

APHA has formally recognized, for at least four decades, the direct and indirect adverse public health consequences of nuclear weapons research, development, testing, production, and use and has also explicitly recognized the essential role of public health professionals in advancing the abolition of nuclear weapons. This policy statement provides an update to the evidence in support of APHA’s past policy statements and reaffirms APHA’s call for the abolition of nuclear weapons. This proposal calls for (1) the United States and the other nuclear weapons states to sign and ratify the 2017 United Nations Treaty on the Prohibition of Nuclear Weapons to pursue good-faith negotiations on effective measures relating to the cessation of the nuclear arms race; (2) the U.S. Congress and president to work toward the goal of a world free of nuclear weapons including, but not limited to, rejoining the Intermediate-Range Nuclear Forces Treaty, renewing and expanding the New Start Treaty, pursuing multilateral regional treaties, renouncing first use of nuclear weapons, and ending the sole presidential authority to launch a nuclear attack; (3) the U.S. Congress and president to address legacy and current occupational and environmental health harms posed by the U.S. nuclear weapons complex; and (4) all public health professionals and schools of public health to advocate for a world free of nuclear weapons, including opposing diversion of resources to weapon development and production, providing instruction on the health impacts of the nuclear weapons cycle in schools of public health, and conducting further research and publishing materials on nuclear weapons issues.

Relationship to Existing APHA Policy Statements
APHA has long been on record in acknowledging the direct and indirect adverse public health consequences of nuclear weapons research, development, testing, production, and use and has underscored the role of public health professionals in advancing the efforts to abolish nuclear weapons. APHA policies on this topic include the following:

  • APHA Policy Statement 20105: Prioritizing Cleanup of the Hanford Nuclear Reservation to Protect the Public’s Health
  • APHA Policy Statement 20095: The Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War
  • APHA Policy Statement 200718: Opposition to US Attack on Iran
  • APHA Policy Statement 200324: Opposition to United States Plans for New Nuclear Weapons Development and Pre-emptive War
  • APHA Policy Statement 200119: Opposition to National Missile Defense and the Militarization of Space

The following related policies have been archived or will be archived this year.

  • APHA Policy Statement 9932: Nuclear Weapon Free World
  • APHA Policy Statement 9931: Taking Nuclear Weapons Off Alert
  • APHA Policy Statement 9804: Cessation of Continued Development of Nuclear Weapons
  • APHA Policy Statement 9605: Cessation of Nuclear Testing and Abolition of Nuclear Weapons
  • APHA Policy Statement 9712: Implementation of the Chemical Weapons Convention
  • APHA Policy Statement 8917: Public Health Hazards at Nuclear Weapons Facilities
  • APHA Policy Statement 8531(PP): The Health Effects of Militarism
  • APHA Policy Statement 8307: Nuclear Testing and Dumping of Nuclear Waste Materials in the Pacific Ocean
  • APHA Policy Statement 8117: Nuclear War and Nuclear Weapons
  • APHA Policy Statement 7909: Nuclear Power
  • APHA Policy Statement 7913: World Peace and the Military Budget

Problem Statement
As of April 2020, approximately 13,410 nuclear weapons in the world were held by nine countries. The nuclear weapons states (NWS) include (with the estimated total arsenal size in parentheses) Russia (6,372), the United States (5,800), the United Kingdom (195), France (290), China (320), Israel (90), Pakistan (160), India (150), and the Democratic People’s Republic of Korea (35).[1] APHA has previously determined that it is not possible for a country to “win” or survive a nuclear war,[2] that such a war would kill millions of people both directly and indirectly, and that such a war cannot be limited geographically. Public health professionals are uniquely positioned to play a robust role in abolishing nuclear weapons. Indeed, a previous APHA president, Dr. Victor W. Sidel, and renowned public health champion Dr. H. Jack Geiger were, together with other physicians, coauthors of seminal articles in the New England Journal of Medicine in 1962 on the critical role of health professionals in preventing nuclear war.[3]

Research, testing, production, manufacturing, storage, and use of nuclear weapons have harmed health: The United States used nuclear weapons on the populations of Hiroshima and Nagasaki in August 1945, killing close to a quarter million people by the end of that year.[4] Short-term mortality and morbidity included severe burns, blast-associated trauma, and acute radiation toxicity.[5] Epidemiological studies of atomic bomb survivors have demonstrated long-term increased risks of hematopoietic malignancies and solid cancers in addition to thyroid disease, chronic liver disease, hypertension, and uterine myomas.[6] In utero exposures increased the risk of severe intellectual disability, small head size, and decreased IQ scores in offspring.[7] The use of nuclear weapons also caused profound and persistent social and mental health consequences.[8] In the short term (2–3 weeks), Japanese atomic bomb survivors suffered “emotional stupor,” characterized by emotional numbness and latency of emotional response.[9] Likewise, increased neurotic and depressive disorders were noted 3 months after the attack.[10] Note that posttraumatic stress disorder did not exist as a concept, let alone a diagnosis, until nearly 30 years later. These effects do not dissipate with time. In 1997, 52 years after the bombings, a survey-based study on the survivors of the Nagasaki bombing revealed severe apathy, disordered relationships, and anhedonia.[11] The very anticipation of a nuclear war increases the risk of mental illness. Adolescents surveyed 2 months preceding the outbreak of the Persian Gulf War in 1991 were again surveyed in 1995. Findings demonstrated a twofold risk of common mental disorders among adolescents reporting fear of nuclear war once a week or more often.[9] In 1983, the World Health Organization concluded that “the only approach to the treatment of the health effects of nuclear explosions is primary prevention of such explosions, that is the prevention of atomic war.”[12]

Scientists have modeled a potential conflict involving no more than a few hundred nuclear weapons similar to the size used on Hiroshima; the resulting global environmental damage would threaten the food supply and lead to mass starvation worldwide. Specifically, a regional conflict between India and Pakistan, limited to 100 to 150 weapons used on each side, could lead to global cooling by 2 to 5 degrees Celsius. With a decline in surface sunlight blocked by explosive-related particulates and debris and associated reductions in precipitation ranging from 15% to 30%, agricultural productivity would decrease by 15% to 30% on land, resulting in a “nuclear famine” for up to 2 billion people and further global collateral fatalities.[13,14]

Nuclear weapons research, testing, and production have resulted in widespread contamination of our air, water, soil, and ecosystems. From 1945 to 1980, the United States, the Soviet Union, China, the United Kingdom, and France conducted more than 500 atmospheric tests—the equivalent of 440 megatons of TNT. Radioactive fallout from atmospheric testing was dispersed worldwide, and downwind exposure was associated with an increased prevalence of thyroid cancer and leukemia.[15] The National Cancer Institute has estimated that atmospheric testing at the Nevada Test Site resulted in 11,300 to 212,000 additional cases of thyroid cancer in the United States.[16] Global testing of nuclear weapons revealed large doses of radioactive exposures among unsuspecting populations and an estimated tens of thousands of fatal cancers as of 2000.[17].

The United States has over 40,000 hazardous sites for nuclear weapons waste; the cleanup cost so far is $41.1 billion.[18] The Waste Isolation Pilot Plant in New Mexico is the only operational deep geological repository for military-generated nuclear waste in the United States, and its permitted operational lifetime ends in 2024; nevertheless, the U.S. Department of Energy is currently undertaking plans to use the site for long-term disposition of surplus plutonium and conducting other activities being challenged in court as mechanisms to extend the facility’s operational lifetime and capacity beyond the existing permit.[19,20] Worldwide, tons of plutonium and highly enriched uranium are not properly secured, posing a risk of nuclear theft and diversion into weapons programs.[21] In addition, some spent nuclear fuel is not readily transportable, and railway transport, the current preferred mode, cannot ensure safety.[22]

Numerous incidents involving releases of nuclear weapons–related radioactive materials have occurred since the 1940s. The 1957 Kyshtym disaster in Russia led to acute hematopoietic reactions to radiation exposure and long-term health harms, including a higher incidence of infectious, endocrine, nutritional, metabolic, and gastrointestinal diseases, among the exposed population.[23] Unintentional releases have also involved nuclear armed delivery systems that have narrowly failed to detonate, including releases from the Damascus Titan missile explosion in 1980 and the 1961 Goldsboro B-52 crash.[24]

Former plutonium production sites in Washington and Tennessee are highly contaminated. The Hanford site alone, during its 50 years of operation, produced 500 million gallons of highly radioactive, chemically toxic waste, some of which is being released directly into the environment. Soil and groundwater are extensively contaminated.[25]

The long-lived nature of radioactive and other environmental releases from the nuclear weapons cycle ensures timeless human exposure. The National Academy of Sciences reports that, “[a]t many sites, radiological and non-radiological hazardous wastes will remain, posing risks to humans and the environment for tens or even hundreds of thousands of years. Complete elimination of unacceptable risks to humans and the environment will not be achieved, now or in the foreseeable future.”[26]

First use and hair-trigger alerts create risk for using or unintentionally launching nuclear weapons: According to the most recent Nuclear Posture Review (2018), the United States “has never adopted a ‘no first use’ policy regarding nuclear weapons,” and it “remains the policy of the United States to retain some ambiguity regarding the precise circumstances that might lead to a U.S. nuclear response.”[27] Also, “the United States will maintain a portion of its nuclear forces on alert day-to-day and retain the option of launching those forces promptly.”[27] As of 2017, the United States, Russia, France, and Britain had an estimated 1,869 nuclear warheads on alert, ready to be used on relatively short notice, with the United States and Russia deploying 1,749 warheads combined (94%). The United States possesses an estimated 892 warheads on prompt alert, ready to be launched within 15 minutes, upon orders from the U.S. president (including 392 intercontinental ballistic missiles and 460 ballistic missile submarines).[28] Many of today’s nuclear weapons are more than 80 times as powerful as the bomb dropped on Hiroshima.[29,30] Of the 1,750 warheads deployed by the United States, approximately 1,300 are deployed on ballistic missiles, with another 300 at U.S. strategic bomber bases. In addition, 150 U.S.-owned bombs are in Europe.[31]

A policy allowing a U.S. president to independently launch a weapon could be catastrophic: The president legally maintains complete control over the U.S. nuclear arsenal. No one in Congress, the judicial branch, or even the U.S. military can use legal means to prevent the use of nuclear weapons once the president’s order is given.

The costs of nuclear weapons divert resources from public health: The Department of Energy oversees the U.S. nuclear weapons research and development program at federal laboratories such as the Sandia National Laboratory, the Los Alamos National Laboratory in New Mexico, and the Lawrence Livermore National Laboratory in California. Several large corporate contractors directly operate these federal laboratories with compensation of billions of dollars in outstanding contracts.[32]

Between 1945 and 1996, the United States spent $5.5 trillion on nuclear weapons and related programs. This expenditure exceeded all other categories of government

spending during that period with the exception of nonnuclear national defense and Social Security.[33] It is expected that modernization, maintenance, and storage of nuclear weapons will cost $494 billion over the next decade, with costs rising each year.[34] According to the U.S. Congressional Budget Office, the United States plans to spend an estimated $1.2 trillion, approximately $4 million an hour, to upgrade and modernize its nuclear weapons and delivery systems over the next 30 years.[35] Cleanup, an illusory concept, is also expensive; complete remediation costs were estimated to be $50 to $60 billion in 2004.[36] Even without the additional plans to upgrade and modernize weapons and remove known nuclear waste, the United States currently spends a total of $22.43 billion in tax dollars per year on nuclear weapons and associated costs, funds that otherwise could support more than 302,000 clean energy jobs, Veterans Administration medical care for more than 2.17 million returning military veterans, 277,511 elementary school teachers for 1 year, or wind power for almost 39 million households.[37] In addition, such expenditures could instead be used to address major deficiencies in U.S. and global public health infrastructure and access to health care, revealed most recently by the COVID-19 pandemic, which weaken national security by creating vulnerabilities that include lowering population resilience to infectious disease, other biological threats, or future pandemics as well as decreasing military readiness.[38–41]

Every link in the chain of nuclear weapons production creates social inequities and injustices: Indigenous, colonized, and minority populations experience disproportionate detrimental health and environmental effects from the nuclear weapons development and production cycle.[42] While indigenous lands have served as the main sites for testing nuclear weapons around the world, they have also been a major source of weapons material. For example, the uranium for the Hiroshima bomb was mined in the then Belgian Congo, and a large proportion of uranium mining during the Cold War (20%–50%) was done in Africa.[43] In North America, multiple indigenous tribes have been affected by testing and disposal of radioactive material, including from open uranium mines on the Spokane Indian Reservation in Washington and the Navajo Nation in Arizona, Utah, and New Mexico. In fact, the largest release of radioactive materials in the continental United States occurred in 1979 as a result of an evaporation pond dam breaking at a processing site near Church Rock, New Mexico, leading to the release of 94 million gallons of radioactive waste into the Puerco River, which flowed through nearby communities.[44] Attempts to establish Yucca Mountain (an important site to the Western Shoshone and the Southern Paiute) as a long-term civilian nuclear waste site pose similar risks.[45]

Between 1946 and 1958, nuclear weapons testing by the United States on or near the Bikini and Enewetak atolls in the Pacific vaporized islands that had been the homeland of the Marshallese people for many generations. These 65 tests released approximately 6.3 billion curies of radioactive iodine into the atmosphere, an amount 42 times greater than the total amount emitted from the Nevada Test Site and at least 116 times greater than the amount released in the 1986 Chernobyl meltdown.[46] The documented findings of the environmental contamination of several atolls were hidden from the general public and the Marshallese people, and heavily exposed research subjects were not treated adequately for radiation burns or given prophylactic antibiotics.[46] For more than three decades, the U.S. government sponsored several thousand human-radiation experiments, many without informed consent, including secret intentional releases of radiation in overpopulated areas.[47] Today, on Runit Island, there is a 3.1 million cubic foot dome of radioactive material from the contaminated debris and soil of 43 nuclear bombs. Radioactive materials have already leaked from the dome, with a great danger of further leakage from concurrent rising ocean levels caused by global warming.[45,48] Some Marshallese remain nervous about marriage out of fear of passing genetic mutations to their offspring. Alcohol abuse and suicide are exceedingly high, and the shift away from local fishing because of legacy contamination to dependence on U.S. food aid has been associated with an epidemic of diabetes.[49]

Soldiers have also been disproportionately harmed by nuclear weapons testing. For example, a 1995 study of 8,550 military participants in Operation Hardtack I, a 1958 test in the Pacific Proving Ground, showed significantly elevated relative risks of all-cause mortality, all cancers, and liver cancer .[50] Workers throughout the nuclear weapons production cycle have also been exposed to radioactive and toxic materials. More than 600,000 people worked throughout the weapons complex during the Cold War. Occupational disorders due to weapons production include, but are not limited to, radiation-induced cancers, beryllium diseases, and silicosis.[51] The Energy Employees Occupational Illness Compensation Program, run by the Department of Labor, was created by Congress in 2000; however, because a high burden of proof is imposed on exposed workers, the program has rejected almost two thirds of the claims in which radiation dose reconstructions were performed.[52]

Nuclear power as a pathway to nuclear weapons: Nuclear power is intrinsically linked to nuclear weapons proliferation. There are over 450 nuclear reactors operating in some 30 countries around the world[53]; these operations provide the materials and technical expertise for potential weapon development. Since the late 1930s, 31 countries have explored the possibility of developing nuclear weapons programs, with 17 of these countries launching programs and 10 acquiring deliverable nuclear weapons.[54]

For example, the first nuclear weapon detonation by India in 1974, described as a “peaceful nuclear explosion,” involved plutonium derived from the CIRUS (Canada India Research Utility Service) reactor; the United States supplied heavy water, and Canada provided financing and technical expertise.[55] This event initiated the dangerous nuclear arms race in South Asia whereby India and Pakistan subsequently perfected delivery systems and increased their nuclear arsenals.[56] This combustible situation was exacerbated by the signing of the U.S.-India Civilian Nuclear Cooperation Agreement in 2006.[57]

With the collapse of the 2015 Iran Nuclear Deal (as described below),[58] the possibility of a new Mideast nuclear arms race has increased, exemplified through the opening of a nuclear power plant by the United Arab Emirates in August 2020 and other Arab countries such as Saudi Arabia initiating or planning nuclear power programs.[59,60]

Key nuclear weapons treaties are being abandoned: Treaties have played a critical role in primary prevention of health harms by diminishing atmospheric dissemination of radionuclides and containing the number and distribution of nuclear weapons to reduce risk. As of 2020, however, the global treaty regime has shown signs of unraveling.

In 1963, the Partial Test Ban Treaty banned nuclear weapon tests in the atmosphere, outer space, and underwater. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) was enacted in 1968 to stem proliferation by prohibiting the acquisition of nuclear weapons by non-NWS and establishing a binding agreement by NWS to pursue timely nuclear disarmament.[61] The NPT also resulted in the negotiation of nuclear weapon free zones as a demonstration of meeting treaty obligations and successfully prohibited the manufacturing, possession, and deployment of nuclear weapons in certain parts of the world.[62] In 1987, at the height of global nuclear arsenals and intense U.S.-Soviet tensions, the Intermediate-Range Nuclear Forces (INF) Treaty was negotiated, opening the possibility of further limitations on strategic nuclear and conventional ground-launched ballistic weapons, a critical step toward elimination.[63]

The Comprehensive Nuclear Test Ban Treaty, opened for signature in 1996, established a verification regime including seismic, hydro-acoustic, infrasound, and radionuclide monitoring stations to register underground or atmospheric testing.[64] As of October 2020, 168 states had signed and ratified the treaty. The United States, China, Iran, and Israel have signed but not ratified the treaty; both steps are required for the treaty to enter into force.[65]

In 1999, 140 nations of the United Nations General Assembly voted to reaffirm the Outer Space Treaty, which preserves the use of outer space for peaceful purposes, by adopting a resolution titled “Prevention of an Arms Race in Outer Space.” The United States voted against the resolution, and Israel abstained.[66] The Anti-Ballistic Missile Treaty once served as a control against the militarization of space; however, the United States withdrew from the treaty in 2002.[67]

The 2011 New Strategic Arms Reduction Treaty (New Start) renewed and expanded on the Start I and II Treaties, further reduced nuclear arsenals, and created a verifiable agreement between the United States and Russia. However, this agreement will expire in 2021 without a plan for renewal.[68] To bypass the stalling of nuclear disarmament by NWS, 122 nations voted to pass the Treaty on the Prohibition of Nuclear Weapons in 2017.[69] As of October 2020, the treaty had garnered 84 signatories and 47 states parties. Although all NWS have opposed the treaty, a minimum of 50 states parties is required to have it enter into force, which in effect would make nuclear weapons illegal under international law [69].

In May 2018, the United States unilaterally withdrew from the 2015 Joint Comprehensive Plan of Action, under which Iran dismantled much of its potential nuclear weapons program and had provided international inspectors with extensive access to its nuclear facilities in exchange for relief of severe economic sanctions.[58] After the United States reimposed severe sanctions on Iranian oil exports that crippled the country’s economy, Iran resumed some of its nuclear activities and, in 2020, announced its intentions to end most of its commitments to the plan.[70]

In August 2019, the Trump administration officially withdrew from the INF Treaty, claiming that Russia had violated the terms of the treaty and providing the United States with additional military options to counter China’s rise in military capabilities.[71] Although China had nuclear weapons at the time the INF Treaty was signed in 1987, it has since developed a larger and more diverse arsenal, 95% of which would have been prohibited by the INF Treaty had China been a signatory [71].

In May 2020, the Trump administration decided to withdraw from the Open Skies Treaty, which permits the United States and Russia to conduct short-notice, unarmed reconnaissance flights over the other countries to collect information on military activity, with the rationale that Moscow was violating the treaty by not allowing flights over a suspected nuclear weapons deployment site and a major Russian military exercises site.[72].

Rising dangers of U.S. and global nuclear weapons modernization programs: According to the Federation of American Scientists, “all the nuclear weapon states continue to modernize their remaining nuclear forces, adding new types, increasing the role they serve, and appear committed to retaining nuclear weapons for the indefinite future.”[1] The plans of the United States to rebuild essentially all of its nuclear weapons and delivery systems with new designs and capabilities will likely fuel tensions with Russia and China. This new nuclear arms race is exacerbated by the parallel development of hypersonic missiles (capable of delivering nuclear or conventional weapons over long ranges at ultra-high velocities) by the United States, Russia, China, India, France, and other nations. Such very accurate, nuclear-capable missiles can reach nearly every point on the surface of the earth within 30 minutes, with no current defense systems having the ability to intercept missiles that are able to maneuver so unpredictably at hypersonic speeds.[73] A further threat of destabilization is posed by the anticipated increased incorporation of autonomous systems and artificial intelligence (AI) into both nuclear command, control, and communications systems (NC3) and nuclear delivery platforms and vehicles, which could increase the potential for accidents and miscalculations and raise the risk of escalation into nuclear warfare.[74]

In summary, as activist and former U.S. military analyst Daniel Ellsberg stated in his 2017 book The Doomsday Machine: Confessions of a Nuclear War Planner, “The present risks of the current nuclear era go far beyond the dangers of proliferation and non-state terrorism that have been the almost exclusive focus of public concern for the past generation and the past decade in particular. The arsenals and plans of the two superpowers represent not only an insuperable obstacle to an effective global anti-proliferation campaign: they are themselves a clear and present existential danger to the human species, and most others.”[75]

Evidence-Based Strategies to Reduce Nuclear Weapons
Strengthening treaties and advancing opportunities for multilateral diplomatic engagement: Treaties have provided a critical means for arms control, deescalation to reduce risks of nuclear war, and arsenal reduction in relation to nuclear weapons as well as other weapons of mass destruction. Treaties have reduced the global nuclear weapon arsenal from a peak in 1986 of about 70,000 to less than 14,000 at present.[1,76]

As detailed above, there are gaps in the implementation of these treaties, and in some cases there is a lack of participation altogether. NWS are demonstrably not moving in good faith toward cessation of the nuclear arms race per Article VI of the NPT, as underscored by NWS modernization plans and by recent U.S. and Russian withdrawal from the INF. The New Start Treaty will expire in 2021 and would benefit from renewal and expansion. Otherwise, for the first time since 1972 there will be no legally binding agreement between the world’s two largest NWS.[77]

Historic successes in banning the development, production, deployment, and use of other weapons of mass destruction point the way forward, exemplified by the Biological Weapons Convention of 1975,[78] the Chemical Weapons Convention of 1997,[79] and the Anti-Personnel Mine Ban Convention of 1997.[80] These conventions provide a strong legal framework for the successful implementation of verifiable international agreements on and ultimate abolition of nuclear weapons.[81] Additional comprehensive frameworks for reductions in the size and health risks of nuclear arsenals include, but are not limited to, building mutual confidence in negotiations toward verifiable reductions in arsenals[82] and challenging underlying policy frameworks positing that armed states can prevent and repel attacks only if they are prepared to respond in kind.[83,84]

Civil society advocacy for a world free of nuclear weapons: The international community has the authority to bring armed parties to the table for negotiations, as it has in the past, to create further successful solutions. A strong consensus to abolish nuclear weapons is evidenced by widespread global support for the 2017 Treaty on the Prohibition of Nuclear Weapons.[85] The international community has a variety of persuasive powers to bring states to join the treaty.

Back from the Brink (BftB), an approach gaining momentum across the United States, pushes for stepwise, readily achievable measures leading to the ultimate abolition of nuclear weapons. Activism by health professionals and communities under the aegis of BftB is encouraging many state and local jurisdictions to adopt anti-nuclear resolutions, including the U.S. Conference of Mayors; the state legislatures of California, Oregon, Maine, and New Jersey, and the cities of Tucson, Los Angeles, Baltimore, Santa Barbara, Portland (Oregon), and Washington, DC. Health organizations on board include People’s Health Movement USA, Physicians for Social Responsibility, the New Hampshire Public Health Association, and the Maine Medical Association.[86]

Health professionals adding nuclear weapons to the public health agenda: Organizations of health professionals have successfully raised awareness among the public while advocating for strong treaties. Physicians for Social Responsibility was founded in 1961 in recognition that “prevention of nuclear war is the only cure.” This group is the U.S. affiliate of the International Physicians for the Prevention of Nuclear War, a federation of national medical groups from 64 countries. IPPNW was awarded the 1985 Nobel Peace Prize for creating awareness of the catastrophic consequences of atomic warfare and has played an instrumental role in global campaigns to ban landmines and prevent armed violence.[87]

The International Campaign to Abolish Nuclear Weapons, which focuses on mobilizing civil society around the world to support a global nuclear weapon ban treaty, received the Nobel Peace Prize in 2017 for its efforts to raise awareness of the threat of nuclear weapons.[88] The International Red Cross and Red Crescent Movement has also helped strengthen global support of treaties through mobilization of its network of nearly 100 million people.[89] The success of these organizations illustrates the critical role of health professionals in efforts to reduce in number and ultimately abolish nuclear weapons.

Opposing Arguments
Theories of “mutually assured destruction” and “deterrence” purport that armed states can prevent and repel attack if they are positioned to respond in kind. While holding fully operational nuclear weapons could serve to deter an attack by a conventionally or nuclear armed enemy nation (by threatening the attacker with an unacceptable material and human cost of retaliation), the possession and proliferation of such weapons pose the real threat of use of nuclear weapons without warning and/or unintentionally. The historical record points to countless examples of misreading of opponents’ intentions. One example is significant breakdowns in NC3 systems, including numerous false warnings of attacks, whereby devastating nuclear warfare was narrowly averted.[24] Beyond these revelations, current advances in computer modeling have predicted that even a regional nuclear conflict predicated accidentally or by intention (involving even a small fraction of global nuclear arsenals) could plunge most of the planet into a protracted period of loss of sunlight and rapid global cooling characterized by massive crop failures and widespread famine.[13]

The dangers of relying on nuclear weapons for deterrence of attack or attaining geostrategic advantage have been further complicated by the anticipated incorporation of autonomous systems and AI into modernized nuclear warheads, delivery systems, and NC3 systems designed to confidently carry out (or recall in the case of perceived errors) nuclear attacks on various targets. While AI could theoretically correct for “human factors” that have previously created dangerous situations, increased autonomy of such lethal systems from timely human intervention, as well as vulnerability to hacking, raises severe dangers.[90]

Issues surrounding nuclear deterrence have become even more problematic with the planned introduction of hypersonic missiles capable of carrying either nuclear or conventional payloads with unprecedented speed and the purported ability to evade all types of defense systems, including heretofore largely unproven strategic missile defenses. The anticipated use of these missiles will further destabilize the deterrence regime, increasing the possibility of catastrophic “use it or lose it” scenarios whereby any potential incoming attack will precipitate “mutually assured destruction.”[91]

Some national security experts and government officials have argued that the use of nuclear weapons should also be considered to destroy alleged and often hardened targets. These targets would include nuclear weapons stockpiles or production facilities or other weapons of mass destruction (WMD) sites containing biological or chemical weapons in nations lacking a robust nuclear retaliation capability. A safer and more effective strategy to counter WMD proliferation would be for the global community, including the NWS, to strengthen inspection and verification protocols, and increase the necessary funding for such operations, subsumed under the Biological Weapons Convention and Chemical Weapons Convention treaties.[92] In addition, efforts to curb nuclear proliferation would include the NWS speedily moving toward compliance with the comprehensive nuclear disarmament goals mandated under Article VI of the NPT, which could include the development of an enforceable nuclear weapons convention or ratification and enforcement of the 2017 Treaty on the Prohibition of Nuclear Weapons.[61,85]

While civilian nuclear energy programs have historically been linked to the development of nuclear weapons programs, nevertheless nuclear power has been supported by some who are legitimately concerned about reducing global reliance on fossil fuels in light of our climate emergency. Proponents contend that operating reactors emit far less carbon emissions than burning fossil fuels. However, a life-cycle analysis of nuclear power reveals that it is far from carbon free when one includes the carbon footprint of creating nuclear fuel or the construction of nuclear power plants. Moreover, real and potential safety problems of nuclear power threaten public health, as exemplified by the 1986 explosion of the Chernobyl nuclear power plant, the 2011 Fukushima Daiichi nuclear disaster, and the maintenance of numerous aged facilities well beyond their initially designated life span. Moreover, a wide array of adverse health and environmental impacts from the operation of nuclear power plants have been documented.[93,94] Nonnuclear renewable energy sources are increasingly available for speedier incorporation into the power grid at a favorable cost advantage relative to nuclear or fossil-fuel alternatives; this militates against the maintenance or expansion of nuclear power as a climate solution.[95–97] This is especially true given the lack of societal planning for health-protective disposition of legacy and continued dangerous nuclear wastes[98] as well as the historic and continued stimulus for nuclear weapons proliferation.

Action Steps
1. APHA calls on the U.S. president and Senate and the other nuclear-weapons states to sign and ratify the 2017 United Nations Treaty on the Prohibition of Nuclear Weapons and to honor their existing binding commitments under Article VI of the Treaty on the Non-Proliferation of Nuclear Weapons to “pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control.”

2. APHA calls on the U.S. Congress and president to work toward the goal of a world free of nuclear weapons by:

  • Supporting any and all current and future treaties that call for the end to nuclear weapons testing, research, development, manufacture, and/or use.
  • Rejoining and working for the strengthening of the INF Treaty while exploring the initiation of negotiations with other countries that either possess or are attempting to develop intermediate nuclear forces, with the aim of incorporating such nations into the INF disarmament regime.
  • Extending the New Start Treaty.
  • Pursuing multilateral regional treaties to encourage nonnuclear states to renounce proliferation of nuclear weapons and other weapons of mass destruction.
  • Supporting speedy and comprehensive, mutually reinforcing confidence-building measures toward reducing nuclear arsenals to 500 to 1,000 among major nuclear weapons states as a preliminary step in ultimate nuclear abolition.
  • Renouncing the option of using nuclear weapons first.
  • Ending the sole, unchecked authority of any U.S. president to launch a nuclear attack.
  • Taking nuclear weapons off hair-trigger alert.
  • Canceling plans for enhanced, destabilizing weapons (i.e., long-range stand-off weapons, hypersonic missiles).
  • Rejecting nuclear war fighting doctrines using “low-yield” nuclear weapons.
  • Halting and prohibiting all programs aiming to integrate autonomous systems and AI into nuclear warheads, weapon delivery systems, and/or NC3 systems.
  • Canceling destabilization programs that would further militarize outer space, including the development of a U.S. space force.
  • Rejoining the Joint Comprehensive Plan of Action with Iran to continue the verifiable reversal of a potential Iranian nuclear weapons program that could stimulate additional nuclear weapons programs in the Middle East.
  • Rejoining the Open Skies Treaty.

3. APHA calls on the U.S. Congress and president to address legacy and current occupational and environmental health harms posed by the U.S. nuclear weapons complex by ensuring adequate long-term investment in research, worker protections, health care, and environmental cleanup of facilities and communities whose health and ecosystems have been damaged by nuclear weapons research, development, testing, and production, as well as ensuring related radioactive and toxic waste containment in perpetuity. This includes the set of action steps proposed in APHA Policy Statement 20105 (Prioritizing Cleanup of the Hanford Nuclear Reservation to Protect the Public’s Health). These steps should be applied to all facilities.

4. APHA calls on all public health professionals and schools of public health to advocate for a world free of nuclear weapons by educating themselves, students, the public, and policymakers on the critical need for rapid nuclear disarmament, including supporting curriculum development and uptake and research, monitoring, publication, and dissemination of information about the direct and indirect public health consequences of nuclear weapons and the public health imperative to abolish nuclear weapons.

1. Kristensen HM, Korda M. Status of world nuclear forces. Available at: Accessed July 13, 2020.
2. American Public Health Association. APHA policy statement 8117: nuclear war and nuclear weapons. Available at: /policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/10/14/59/nuclear-war-and-nuclear-weapons. Accessed October 5, 2020.
3. Sidel VW, Geiger HJ, Lown B. The medical consequences of thermonuclear war. II. The physician’s role in the postattack period. N Engl J Med. 1962;266(22):1137–1145.
4. Yokora K, Kamada N. The public health effects of the uses of nuclear weapons. In Levy BS, Sidel VW, eds. War and Public Health. Washington, DC: American Public Health Association; 2000.
5. Jordan BR. The Hiroshima/Nagasaki survivor studies: discrepancies between results and general perception. Genetics. 2016;203(4):1505–1512.
6. Sakata R, Grant E, Ozasa K. Long-term follow-up of atomic bomb survivors. Maturitas. 2012;72(2):99–103.
7. Kotaro O, Cullings H, Ohishi W, Hida A, Grant E. Epidemiological studies of atomic bomb radiation at the Radiation Effects Research Foundation. Int J Radiat Biol. 2019;95(7):879–891. 
8. Zwigenberg R. Healing a sick world: psychiatric medicine and the atomic age. Med Hist. 2018;62(1):27–49.
9. Poikolainen K, Setala T, Tuulio-Henriksson A, et al. Fear of nuclear war increases the risk of common mental disorders among young adults: a five-year follow-up study. BMC Public Health. 2004;4:1–7.
10. Okumura N, Hikita H. Results of psychoneurological studies on atomic bomb survivors. Kyushu Shinkei Seishin Igaku. 1949;1:50–52.
11. Ohta Y. Psychological effect of the Nagasaki atomic bombing on survivors after half a century. Psychiatry Clin Neurosci, 2001;54(1):97–103.
12. Effects of Nuclear War on Health and Health Services. Geneva, Switzerland: World Health Organization; 1984.
13. Toon OB. Rapidly expanding nuclear arsenals in Pakistan and India portend regional and global catastrophe. Sci Adv. 2019;5(10):eaay5478.
14. Helfand I. Nuclear famine: two billion people at risk? Available at: Accessed October 5, 2020.
15. Simon S, Bouville A, Land C. Fallout from nuclear weapons tests and cancer risks. Am Scientist. 2006;94(1):48.
16. Exposure of the American People to Iodine-131 from Nevada Nuclear-Bomb Tests: Review of the National Cancer Institute Report and Public Health Implications. Washington, DC: Institute of Medicine and National Research Council; 1999.
17. International Physicians for the Prevention of Nuclear War and Institute for Energy and Environmental Research. Radioactive Heaven and Earth: The Health and Environmental Effects of Nuclear Weapons Testing in, on and Above the Earth. New York, NY: Apex Press; 1991.
18. Groeger L, Grochowski Jones R, Lustgarten A. Bombs in your backyard. Available at:,-112.81076834807381,47.119454384567426,-93.49680350432381&c=shrink. Accessed January 29, 2020.
19. National Academies of Sciences, Engineering, and Medicine. Review of the Department of Energy’s Plans for Disposal of Surplus Plutonium in the Waste Isolation Pilot Plant. Washington, DC: National Academies Press; 2020.  
20. Hedden A. WIPP utility shaft project challenged as illegal. Available at: Accessed October 9, 2020.
21. Pomper MA, Tarini G, Nuclear terrorism: threat or not? Available at: 1898:050001. Accessed October 9, 2020.
22. U.S. Government Accountability Office. Spent nuclear fuel: legislative, technical, and societal challenges to its transportation. Available at: Accessed October 9, 2020.
23. Akleyev AV, Krestinina L, Degteva, M, Tolstykh E. Consequences of the radiation accident at the Mayak production association in 1957 (the ‘Kyshtym accident’). J Radiol Prot. 2017;37(3):R19–R42.
24. Schlosser E. Command and Control: Nuclear Weapons Accidents and the Illusion of Safety. New York, NY: Penguin Books; 2013.
25. Crowley KD, Ahearne J. Managing the environmental legacy of U.S. nuclear-weapons production: although the waste from America’s arms buildup will never be “cleaned up,” human and environmental risks can be reduced and managed. Am Scientist. 2002;90(6):514–523.
26. Wald M. Nuclear sites may be toxic in perpetuity, report finds. Available at: Accessed October 9, 2020.
27. U.S. Department of Defense. Nuclear posture review. Available at: Accessed October 9, 2020.
28. Kristensen HM. Alert status of nuclear weapons (version 2). Available at: Accessed October 9, 2020.
29. Hansen C. U.S. Nuclear Weapons: The Secret History. Arlington, TX: Aerofax; 1988.
30. Bennett J. Here’s how much deadlier today’s nukes are compared to WWII A-bombs. Available at: Accessed October 9, 2020.
31. Kristensen HM. United States nuclear forces, 2020. Available at: Accessed October 9, 2020.
32. International Campaign to Abolish Nuclear Weapons. Producing mass destruction: private companies and the nuclear weapon industry. Available at: Accessed October 9, 2020.
33. Schwartz SI. Atomic Audit: The Costs and Consequences of U.S. Nuclear Weapons Since 1940. Washington, DC: Brookings Institution Press; 1998.
34. Congressional Budget Office. Projected costs of U.S. nuclear forces, 2019 to 2028. Available at: Accessed October 9, 2020.
35. Congressional Budget Office. Approaches for managing the costs of nuclear weapons forces, 2017 to 2046. Available at: Accessed October 9, 2020.
36. Lichtenstein ND. The Hanford Nuclear Waste Site: a legacy of risk, cost, and inefficiency. Nat Resour J, 2004;44(3):809–839. 
37. National Priorities Project. Trade-offs: your money, your choices. Available at: Accessed October 9, 2020.
38. Monaco L. Pandemic disease is a threat to national security. Washington should treat it like one. Available at: Accessed October 9, 2020.
39. Hacker JS, Hathaway O. Universal health care is a national security issue. Available at: Accessed October 9, 2020.
40. Mehta A. Public health must be part of national security calculus, says Flournoy. Available at: Accessed October 9, 2020.
41. Cullison TR, Morrison J. The U.S. Department of Defense’s role in health security: current capabilities and recommendations for the future. Available at: Accessed October 9, 2020.
42. Gould R, Sutton P. Nuclear weapons and social injustice. In Levy BS, Sidel VW, eds. Social Injustice and Public Health. New York, NY: Oxford University Press; 2019.
43. Hecht G. An elemental force: uranium production in Africa, and what it means to be nuclear. Available at: Accessed October 9, 2020.
44. U.S. Government Accountability Office. Uranium contamination: overall scope, time frame, and cost information is needed for contamination cleanup on the Navajo reservation. Available at: Accessed October 9, 2020.
45. Rust S. How the U.S. betrayed the Marshall Islands, kindling the next nuclear disaster. Available at: Accessed October 9, 2020.
46. Johnston BR, Barker H. Consequential Damages of Nuclear War: The Rongelap Report. Walnut Creek, CA: Left Coast Press; 2008.
47. U.S. Department of Energy. Final report of the Advisory Committee on Human Radiation Experiments. Available at: Accessed October 9, 2020.
48. Nhemachena A, Mawere M. Necroclimatism in a Spectral World (Dis)order? Bamenda, Cameroon: Langaa RPCIG; 2019.
49. Zak D. A ground zero forgotten. Available at: Accessed October 9, 2020.
50. Watanabe KK, Kang HK, Dalager NA. Cancer mortality risk among military participants of a 1958 atmospheric nuclear weapons test. Am J Public Health. 1995;85(4):523–527.
51. U.S. Congress. Subchapter XVI—Energy Employees Occupational Illness Compensation Program. Available at: Accessed October 9, 2020.
52. Morris J, Hopkins J. Ailing, angry nuclear-workers fight for compensation. Available at: Accessed October 9, 2020.
53. International Atomic Energy Agency. Preliminary nuclear power facts and figures for 2019. Available at: Accessed October 9, 2020.
54. Bleek PC. When did (and didn’t) states proliferate? Chronicling the spread of nuclear weapons. Available at: Accessed October 9, 2020.
55. Comprehensive Nuclear-Test-Ban Treaty Organization. “Smiling Buddha” on 18 May 1974, the first nuclear test explosion conducted by India. Available at: Accessed August 4, 2020.
56. Cheema PI. Anatomizing Pakistan’s motivations for nuclear weapons. Pakistan Horizon. 2011;64(2):5–19.
57. Ghoshroy S. Taking stock: the US-India nuclear deal 10 years later. Available at: Accessed August 4, 2020.
58. Behles C. U.S. withdraws from Joint Comprehensive Plan of Action. Available at: Accessed October 9, 2020.
59. Yee V. U.A.E becomes first Arab nation to open a nuclear power plant. Available at: Accessed August 4, 2020.
60. Mazzetti M, Sanger D, Broad W. U.S. examines whether Saudi nuclear program could lead to bomb effort. Available at: Accessed October 9, 2020.
61. United Nations. Treaty on the Non-Proliferation of Nuclear Weapons. Available at: Accessed October 9, 2020.
62. United Nations. Nuclear-weapon free zones. Available at: Accessed October 9, 2020.
63. Bureau of Arms Control, Verification, and Compliance. Treaty Between the United States Of America and the Union of Soviet Socialist Republics on the Elimination of Their Intermediate-Range and Shorter-Range Missiles. Available at: Accessed October 9, 2020.
64. Comprehensive Nuclear-Test-Ban Treaty Organization Preparatory Commission. What is the CTBT? Available at: Accessed October 9, 2020.
65. Comprehensive Nuclear-Test-Ban Treaty Organization Preparatory Commission. Status of signature and ratification. Available at: Accessed October 9, 2020.
66. Federation of American Scientists. Prevention of an arms race in outer space. Available at: Accessed October 9, 2020.
67. Bureau of Arms Control, Verification, and Compliance, Treaty Between the United States of America and the Union of Soviet Socialist Republics on the Limitation of Anti-Ballistic Missile Systems. Available at: Accessed October 9, 2020.
68. Arms Control Association. New Start at a glance. Available at: Accessed October 9, 2020.
69. International Campaign to Abolish Nuclear Weapons. Signature and ratification status. Available at: Accessed October 8, 2020.
70. Laub Z, Robinson K. What is the status of the Iran nuclear agreement? Available at: Accessed October 9, 2020.
71. Denmark A. U.S.-China military competition intensifying over INF missiles. Available at: Accessed October 9, 2020.
72. Sanger DE. Trump will withdraw from Open Skies Arms Control Treaty. Available at: Accessed October 9, 2020.
73. Simon S. Hypersonic missiles are a game changer. Available at: Accessed October 9, 2020.
74. Horowitz MC, Scharre P, Velez-Green A. A stable nuclear future? The impact of autonomous systems and artificial intelligence. Available at: Accessed October 9, 2020.
75. Ellsberg D. The Doomsday Machine: Confessions of a Nuclear War Planner. New York, NY: Bloomsbury; 2017.
76. Nuclear Threat Initiative. Nuclear disarmament resource collection. Available at: Accessed October 9, 2020.
77. Reif K. As INF Treaty falls, New Start teeters. Available at: Accessed October 9, 2020.
78. U.S. Department of State. Biological Weapons Convention. Available at: Accessed October 9, 2020.
79. Organization for the Prohibition of Chemical Weapons. Chemical Weapons Convention. Available at: Accessed October 9, 2020.
80. United Nations. Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on Their Destruction. Available at: Accessed October 9, 2020.
81. Nuclear Threat Initiative. Proposed nuclear weapons convention. Available at: Accessed August 6, 2020.
82. Pifer S. The next round: the United States and nuclear arms reductions after New Start. Available at: Accessed October 9, 2020.
83. Elworthy S. Beyond deterrence: rethinking UK security doctrine. Available at: Accessed August 4, 2020.
84. Krieger D. Ten serious flaws in nuclear deterrence theory. Available at: Accessed October 9, 2020.
85. United Nations. Treaty on the Prohibition of Nuclear Weapons. Avaliable at: Accessed October 9, 2020.
86. Back from the Brink. Our five policy solution. Available at: Accessed October 9, 2020.
87. The Nobel Prize. International Physicians for the Prevention of Nuclear War, 1985. Available at: Accessed June 28, 2020.
88. The Nobel Prize. The Nobel Prize for 2017. Available at:,based%20prohibition%20of%20such%20weapons.%22. Accessed June 28, 2020.
89. International Red Cross and Red Crescent Movement. Home page. Available at: Accessed October 9, 2020.
90. Geist E, Lohn A. How might artificial intelligence affect the risk of nuclear war? Available at: Accessed October 9, 2020.
91. Speier RH. Hypersonic missile nonproliferation: hindering the spread of a new class of weapons. Available at: Accessed October 9, 2020.
92. Blix H. The role of inspection as a part of the effort to prevent the possession of weapons of mass destruction. Available at: Accessed October 20, 2020.
93. Steinhauser G, Brandl A, Johnson T. Comparison of the Chernobyl and Fukushima nuclear accidents: a review of the environmental impacts. Sci Total Environ. 2014;470–471:800–817. 
94. Fushiki S. Radiation hazards in children—lessons from Chernobyl, Three Mile Island and Fukushima. Brain Devel. 2013;35(3):220–270. 
95. Lifton RJ, Oreskes N. The false promise of nuclear power in an age of climate change. Available at: Accessed August 4, 2020.
96. Lovins AB. Does nuclear power slow or speed climate change? Available at: Accessed August 4, 2020.
97. Jacobson MZ. Impacts of green new deal energy plans on grid stability, costs, jobs, health, and climate in 143 countries. One Earth. 2019;1(4):449–463. 
98. Ross D. Critics alarmed by US nuclear agency’s bid to relax rules on radioactive waste. Available at: Accessed October 9, 2020.